Diagnostic test accuracy of the Emergency Severity Index: a systematic review and meta-analysis
Abstract
Background and importance: Efficient triage of emergency patients is crucial for the immediate identification of critically ill individuals and enables rapid interventions to improve patient outcomes.
Design: Systematic review and meta-analysis of the diagnostic test accuracy (DTA) of the Emergency Severity Index (ESI) for identifying critically ill adult patients in the emergency department (ED).
Settings and participants: We considered all studies (case-control and cohort studies) that evaluated the DTA of the ESI in adult patients attending an ED. The outcome of a triage system is the high urgency of treatment, commonly used reference standards are short-term mortality or admission to an ICU.
Methods: We searched four bibliographic databases up to 13 February 2025. Screening, inclusion, data extraction, and assessment of methodological quality followed standard Cochrane methodology. We calculated measures of DTA for all studies against the reference standards and calculated pooled estimates using a bivariate random effects model.
Main results: We included 27 studies, representing 510 777 patients. Methodological quality according to the QUADAS-2 tool was high, except for risk of bias in patient selection, which was high for 12 (44%) studies. A total of 18 studies provided data for the reference standard short-term mortality, with an estimated pooled sensitivity of 81.8 [95% confidence interval (CI): 71.8-88.9], specificity of 70.5 (60.5-78.8), diagnostic odds ratio (DOR)…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 510 participants or records.
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